Effect of a Mobile Health Application With Nurse Support on Quality of Life Among Community-Dwelling Older Adults in Hong Kong
Authors: Arkers Kwan Ching Wong, Frances Kam Yuet Wong, Karen Kit Sum Chow, Siu Man Wong, Jonathan Bayuo, Annie Ka Ying Ho
Journal: JAMA Network Open (2022)

Importance Mobile health (mHealth) smartphone apps are becoming increasingly popular among older adults, although the reactive care approach of these apps has limited their usability. Objective To evaluate the effects of an interactive mHealth program supported by a health-social partnership team on quality of life (QOL) among community-dwelling older adults in Hong Kong. Design, Setting, and Participants This was a 3-group, randomized clinical trial conducted in 5 community centers in Hong Kong from December 1, 2020, to April 30, 2022, with a last follow-up date of January 31, 2022. Participants included older adults aged at least 60 years who were living within the service area, used a smartphone, and had at least 1 of the following problems: chronic pain, hypertension, or diabetes. Data were analyzed from May 1 to 10, 2022. Interventions Participants were randomly assigned to the mHealth with interactivity (mHealth+I) group, mHealth group, or control group. Participants in the mHealth+I group received the mHealth app and nurse case management supported by a health-social partnership team. The mHealth group received the mHealth app only. The control group received no mHealth app or health-social care services. Main Outcomes and Measures The primary outcome was the change in QOL from baseline to 3 months after completion of the intervention. Results Among 221 participants (mean [SD] age 76.6 [8.0] years; 185 [83.7%] women), 76 were randomized to the control group, 71 were randomized to the mHealth group, and 74 were randomized to the mHealth+I group. The most common chronic diseases or problems were hypertension (147 participants [66.5%]), pain (144 participants [65.2%]), cataracts (72 participants [32.6%]), and diabetes (61 participants [27.6%]). At 3 months after the intervention and compared with the intervention group, there were no statistically significant differences in either the physical component summary (mHealth+I: β = −1.01 [95% CI, −4.13 to 2.11]; P = .53; mHealth: β = 0.22 [95% CI, −3.07 to 3.50]; P = .90) or the mental component summary (mHealth+I: β = −0.87 [95% CI, −4.42 to 2.69]; P = .63; mHealth: β = 1.73 [95% CI, −1.89 to 5.34]; P = .35) QOL scores. Only secondary outcomes, including self-efficacy (β = −2.31 [95% CI, −4.26 to −0.36]; P = .02), systolic blood pressure (β = −2.30 [95% CI, −5.00 to −0.13]; P = .04), pain levels (β = 1.18 [95% CI, 0.52 to 2.00]; P = .02), and health services utilization (β = 0.98 [95% CI, 0.32 to 2.09]; P = .048) improved in the mHealth+I group compared with the control group. Conclusions and Relevance This randomized clinical trial found no difference in the primary outcome between the mHealth+I group and the control group confirming that there were no incremental benefits to adding interactivity in mHealth programs for older adults with chronic diseases. Trial Registration Clinicaltrials.gov Identifier: NCT03878212